个体化导航模板与徒手方法椎弓根螺钉置入的精确性比较:一项荟萃分析  

Comparison of the accuracy of pedicle screw placement between individual navigational template and free hand technique: a meta-analysis

作　　者：贺伍儿 许耀军 都金鹏 张嘉男 樊勇 李勇[3] HE Wu-er;XU Yao-jun;DU Jin-peng;ZHANG Jia-nan;FAN Yong;LI Yong(No.1 Orthopeadic Surgery Department,the People＇s Hospital of Xingping,Xingping 713100;Ward of Spine SurgeryLumbar Vertebra,Xi＇an Honghui Hospital,Xi＇an 710000;No.2 Orthopaedics Department,Yulin No.2 Hospital,Yulin 719000,China)

机构地区：[1]兴平市人民医院骨外一科,陕西兴平713100 [2]西安市红会医院脊柱外科腰椎病区,陕西西安710000 [3]榆林市第二医院骨二科,陕西榆林719000

出　　处：《临床医学研究与实践》2018年第27期7-10,13,共5页Clinical Research and Practice

摘　　要：目的比较个体化导航模板技术与传统徒手方法用于重建脊柱稳定性时椎弓根螺钉置入精确性的差异。方法检索2018年2月之前收录在Cochrane图书馆、Ovid、Web of Science、Pub Med、EMBASE和CNKI数据库中关于上述两种方法的对照研究并进行荟萃分析。筛选出符合纳入条件的文献,提取二分类资料并以优势比(OR)及95%置信区间(CI)表示,用χ2检验和I2统计评估异质性。结果最终纳入12篇文献,包括10篇随机对照试验和2篇前瞻性队列研究。经Cochrane协作网质量评估工具和纽卡斯尔-渥太华质量评估量表评估发现,纳入文献的整体质量较高。个体化导航模板辅助椎弓根螺钉置入的精确性显著高于徒手方法椎弓根螺钉置入[OR(95%CI):4.92(3.78~6.41),P<0.01;其中体外OR(95%CI):5.40(3.93~7.42),P<0.01;体内OR(95%CI):4.01(2.49~6.44),P<0.01]。森林图显示存在中等程度的异质性(χ2=16.10,P>0.1,I2=32%)。亚组分析结果显示,各个亚组异质性检测均无统计学差异(P>0.05)。结论个体化导航模板辅助技术在减少螺钉侵犯椎弓根壁方面优于传统徒手方法。个体化导航模板是提高椎弓根螺钉置入精确性的一种可选辅助工具,但其仍面临许多挑战。Objective To compare the accuracy differences of pedicle screw placement between individual navigationaltemplate and traditional free hand technique for spinal stability reconstruction. Methods The comparative studies of thetwo methods in Cochrane Library, Ovid, Web of Science, PubMed, EMBASE and CNKI databases were searched untilFebruary 2018 and a meta -analysis was conducted. The literatures met the inclusion criteria were screened out, thedichotomous data were extracted and represented by odds ratio （OR） and 95% confidence interval （CI）. The heterogeneitywas evaluated by I^2test and I2statistics. Results Finally, 12 literatures were included, including 10 randomized controltrials and 2 prospective cohort studies. The Cochrane collaborative network quality assessment tool and Newcastle-Ottawaquality assessment scale showed that the overall quality of the included literatures were high. The accuracy of individualnavigational template assisted pedicle screw placement was significantly higher than that of the free hand pedicle screwplacement [OR （95%CI）： 4.92 （3.78-6.41）, P〈0.01; in vitro OR （95%CI）： 5.40 （3.93-7.42）, P〈0.01; in vivo OR （95%CI）：4.01 （2.49-6.44）, P〈0.01]. Forest plots showed there was moderate heterogeneity （χ^2=16.10, P〉0.1, I^2=32%）. Subgroupanalysis results showed that there were no significant differences in heterogeneity among all subgroups （P 〉0.05）.Conclusion Individual navigational template assistance technology is superior to the traditional free hand technique inreducing screw invasion of the pedicle wall. Individual navigational template is an optional assistant tool to improve theaccuracy of pedicle screw placement, but it will face many challenges.

关 键 词：个体化导航模板 徒手方法 椎弓根螺钉置入 精确性 

分 类 号：R687.3[医药卫生—骨科学]